1-4.
GENERAL TECHNIQUES OF PHYSICAL ASSESSMENT
The general techniques of physical assessment are inspection, auscultation,
palpation, and percussion.
a. Inspection. This involves seeking of physical signs by observing the patient.
Inspection depends entirely upon the knowledge of the observer; we tend to see things
that have meaning for us. The two processes that are associated with inspection in this
lesson are general and local inspections.
(1) General inspection involves the initial inspection of the body as a whole.
In looking at the body as a whole, many facts may be noted about the patient's motor
activity, body build, outstanding anatomic malformation, behavior, speech, nutrition, and
appearance of illness (a complex defying description).
(2) Local inspection involves focusing a single anatomic region (head,
chest, abdomen, and so forth). This process of inspection can lead to many physical
signs; for example, a dermatologist relies entirely on the appearance of a wart to make
a decision.
b. Auscultation. This involves the process of listening with a stethoscope to
obtain a patient's physical signs. You will be mainly listening for vascular and breath
sounds.
(1) Vascular sounds. These sounds are caused by the heartbeat or flow of
blood. The heartbeat is normally heard and described as a "lubb-dubb" sound.
(2) Breath sounds. These sounds are respiratory sounds that are
transmitted through the lungs and chest wall. The sounds may be "low or "high-pitched"
and "soft" or "loud," depending on the location. A crackling or a raspy type sound may
also be heard.
c. Palpation. This involves the act of examination by using the sense of touch.
(1)
Perceived signs. Signs are perceived by:
(a) Tactile sense. The tips of the fingers are used. They are sensitive
for fine tactile discriminations.
(b) Temperature sense. The back of the hand is used. The skin is
much thinner than elsewhere on the hand.
(c)
Vibratory sense. The upper palm (the area just below the fingers)
is used.
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